Drug deaths shift from opioid painkillers to heroin and synthetics, such as fentanyl.

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Opioid’s deadly grip on the US continued to tighten in 2015, pushing up death rates across the board, according to new data released Friday by the National Center for Health Statistics, a division of the Centers for Disease Control and Prevention.

Overall, drug overdose deaths rose to 16.3 per 100,000 in 2015—that’s 2.5 times the 1999 rate of 6.1 per 100,000. In that time range, increases were seen for both men and women, as well as across all age groups and races, with whites seeing the most dramatic increases. Generally, overdoses of opioid painkillers continued to be a leading killer, but heroin and synthetic opioids, such as deadly fentanyl, are behind an increasing number of deaths.

The data suggestd a shift away from overdose deaths caused by opioid painkillers. Since 2010, the share of overdose deaths from natural and semisynthetic opioids dropped from 29 percent to 24 percent. In that time frame, heroin deaths increased from 8 percent to 25 percent. Deaths from synthetic opioids (other than methadone), which includes fentanyl, fentanyl analogs, and tramadol, increased from 8 percent to 18 percent.

The states hit hardest by overdose deaths are West Virginia, New Hampshire, Kentucky, and Ohio.